Even though the standard for pre-surgical education has been elevated for bariatric patients seeking treatment for obesity with weight loss surgery a certain silliness prevails among patients and the public suggesting surgery is the easy way to lose weight. Popular perception of surgical weight loss suggests that lifestyle changes including diet and exercise are not necessary for weight loss; the surgery does all the work for the patient by restricting caloric intake.

The truth is, in order to lose weight and maintain the resulting healthy body weight with weight loss surgery (gastric bypass, gastric lap-band, gastric sleeve) one must make significant lifestyle changes that include a following high protein diet, the elimination of processed carbohydrates and carbonated beverages, and avoiding or at least controlling snacking or mindless eating. In addition patients must engage in daily physical activity beyond the physical motions of the routine day. Patients must exercise. A lapse in adherence to the dietary or activity requirements of bariatric surgery will cause weight loss to cease and may potentially cause weight gain.

The notion that simply eating less of the things we were eating at the height of our obesity as a means to losing weight is absurd. Yet I have heard the hearty laugh of a post-surgical patient more than once when they explain, "I can still eat the same things I used to eat, just less!" Okay, how about we check back with that person in a year or so and see how that is working. Chances are the last thing they want to talk about, let alone laugh about, is weight loss surgery. The patients and the public that want to believe weight loss surgery is easy weight loss do not want to hear this simple truth: If the food you ate before surgery made you fat then eating the same food, even less of it, after surgery will continue to keep you fat. It is that simple.

Most bariatric programs explain to their patients that the surgical stomach pouch is "only a tool" for losing weight and some programs make patients sign a contract affirming they will use their tool correctly. To use the tool correctly the patient must follow the prescribed diet and exercise program. Not for just a few weeks or until goal weight is accomplished. The surgery is a permanent alteration of the human digestive system therefore the patient must make a permanent alteration of their behaviors in a conscious effort to use the tool for controlling the metabolic disorder we call obesity.

Even with surgery patients must diet and exercise to lose weight. To maintain that weight loss they will continue to follow the high protein diet and exercise requirements for the rest of their life. Patients who do this are happily successful with their "easy" weight loss surgery. Patients who from the first stitch ignored these requirements hoping the surgery would do the work for them are not laughing much now as they try to fade in the background doing the same things they have always done hoping for different results.

In my work I counsel patients of weight loss surgery who often ask me if it is okay to eat this or that. My job is not to fork feed these people, my job is to give them the power to rule their own fork. So I answer this question like this, "When you are looking at or longing for that deep fried food at the county fair use your dietary sensibility and remember that if it made you fat before surgery it will surely make you fat after surgery."